Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) has defended its use of controversial Electroconvulsive Therapy (ECT, sometimes referred to as shock therapy) after new figures and a national audit prompted calls for an urgent review of the treatment’s risks, consent processes and evidence base.
NHS England data show 115 patients received ECT at TEWV in 2024/25, the second‑highest total reported by any provider and about 14 times higher than the three lowest using trusts according to NHS data for 2024/25.
ECT involves applying an electric shock to the brain in order to cause a seizure, under general anaesthetic, in an effort to alleviate severe depression. A course typically involves between 8 and 12 shocks, at a rate of two or three times a week. This equates to roughly 1,150 individual treatments administered annually.
Independent audit
An independent audit led by Dr John Read, Professor of Clinical Psychology at the University of East London, reports large regional variation in usage, a majority of recipients being women and over‑60s, and high levels of treatment without patient consent in some trusts.
In the 2019 audit, TEWV delivered ECT without consent to 70.7% of recipients, roughly double the national rate then identified.
The audit also documents limited use of validated outcome measures and sparse adverse‑effects monitoring, prompting its call for an independent government‑sponsored review of ECT in England.
Trust response
Responding for TEWV, Kedar Kale, medical director, said: “Electroconvulsive Therapy is a recognised, evidence‑based treatment recommended by the National Institute for Health and Care Excellence (NICE) for people with severe mental illness.
“It may be used when a person has previously found it helpful, when all other treatments haven’t worked, or in life threatening situations.”
Kale added: “Use of this therapy is strictly monitored, and our electroconvulsive therapy services are externally accredited by the Royal College of Psychiatrists as meeting their national standards for quality and safety.”
“The treatment, like all of our care and treatment plans, puts patients at the very heart of decision making,” he said.
“Electroconvulsive therapy is only delivered following a thorough assessment of the benefits and risks to the individual. This includes exploring all other appropriate treatment options and considering the most appropriate care for the person’s needs.”
Responding to concerns about its high ECT usage, the Trust argues that “the area covered by our Trust includes some of the most deprived neighbourhoods in the country, which contributes to poorer social, physical and mental health outcomes.
“Sometimes people we care for cannot consent to treatment because they are too unwell,” it added. “In these cases, we follow the Mental Health Act and seek a second opinion from a Second Opinion Appointed Doctor (SOAD), an independent psychiatrist who checks that the treatment is appropriate and safeguards the patient’s rights.”
No evidence base
But the audit’s lead author disputes the Trust’s account.
Dr Read said: “ECT is most definitely not evidence-based. There has not been a single placebo controlled study on ECT for depression since 1985, and the few before that were hopelessly flawed.
“There is no evidence that ECT prevents suicide, as implied by the claim about life-threatening situation.”
Refuting the Trust’s claims on monitoring, he said: “ECT is not monitored at all. The Care Quality Commission has informed us they have never visited an ECT suite.
“The [Royal College of Psychiatrists] has vehemently denied, in writing, that they have a monitoring role.”
Read further argued: “How can electric shocks and seizures alleviate problems that are caused by social factors like loss, loneliness, isolation and financial struggles?
“How can you claim to put patients ’at the very heart of decision making’ when you are giving ECT to so many people against their will?
“It seems that if a patient agrees to ECT they are deemed to have the capacity to consent. But if they say they don’t want ECT they are often deemed not to have capacity and are forced to have the treatment against their will. It’s a catch-22 situation for the patient.”
Separately, Dr Read urged action: “ECT carries a high risk of persistent or permanent memory loss, along with a range of other adverse effects, such as emotional numbing and cardiovascular problems.
“While a minority experience a very short-term lift in mood, there is no evidence that ECT has any benefits, compared to placebo, beyond the end of the treatment period.
“Between 12% and 55% of patients experience persistent or permanent memory loss as a result, but we know from our research that patients are rarely told that.”
“Trust managers may wish to launch an urgent inquiry into the overuse of this controversial, high-risk procedure, including whether patients and their families are being given evidence-based information about its risks and the absence of any long-term benefits.
“The huge variation around the country in ECT usage seems to come down to the subjective, personal opinions of individual psychiatrists in different Trusts.
“It really is a postcode lottery rather than an evidence-based process.”
Ultimately, the dispute over TEWV’s high use of ECT points to a system in which oversight is inconsistent, evidence is contested and patient consent far from assured.
Until those issues are independently examined, patients across England will continue to receive a therapy whose long‑term outcomes and ethical foundations remain unresolved, and whose use appears driven less by clinical necessity than by postcode.
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South West Durham News covering news across County Durham.
It is a shame Dr Kedar Kale is not concerned his colleagues within the Trust have Factitious Disorder Imposed on Another, formerly known as Munchausen’s Syndrome by Proxy. Neither nursing Director nor medical director will accept there is a problem which is of course the typical response when discussing Factitious Disorder Imposed on Another. Harm to patients and lack of treatment for staff is a concern no one in Safe Guarding has ever wished to consider. The new CEO Alison Smith shows no concern either, she is not belle indifferent, but she is laissez faire and risks harm to patients and staff!